Provider Demographics
NPI:1194176966
Name:HUECHTKER, ANGIE KAY (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:ANGIE
Middle Name:KAY
Last Name:HUECHTKER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MRS
Other - First Name:ANGELA
Other - Middle Name:KAY
Other - Last Name:HUECHTKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:1624 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2818
Mailing Address - Country:US
Mailing Address - Phone:803-454-0364
Mailing Address - Fax:
Practice Address - Street 1:1317 EBENEZER RD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-2336
Practice Address - Country:US
Practice Address - Phone:803-207-8177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-23
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2117225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist